Finals sir Erich_ fractures And Complications

Question 1

any disruption in the continuity of the bone, when more stress is placed on it than it can absorb

Answer 1

Fractures

Question 2

compound or complex) break in tissue over site of the bone injury

Answer 2

Open fracture

Question 3

break across entire cross-section of bone & often displaced

Answer 3

Complete Fracture

Question 4

(greenstick) though only part of the cross-section

Answer 4

Incomplete Fracture

Question 5

: (simple) intact skin over site of injury

Answer 5

Closed Fracture

Question 6

produces several bone fragments

Answer 6

Comminuted

Question 7

Characterized by neurologic dysfunction, pulmonary insufficiency, and petechial rash on chest, axilla & upper arms

Answer 7

FAT EMBOLISM SYNDROME

Question 8

Age of people having complication of fat embolism

Answer 8

Age 20-30 yrs old

Question 9

Manifestations of fat emboli occur within 24-72 hours but may be up to a week after injury:

Answer 9

Hypoxia PaO2 < 60 mm Hg
Tachypnea, tachycardia, pyrexia
Deterioration in LOC
Confusion , agitation
Respiratory distress response – tachypnea, dyspnea, crackles, wheezes, precordial chest pain, copious thick white sputum, tachycardia petechiae: chest, shoulders, axilla, mouth, conjunctival sac

Question 10

Preventionof Fat Embolism

Answer 10

Immobilize fractures: early & gentle stabilization
Gentle care
Adequate hydration
O2
Aware of those at high risk

Question 11

Management for Fat Embolism

Answer 11

O2
Fluid replacement Mechanical ventilation Corticosteroids
Vasoactive medications Maintain Hgb
Calm, supportive environme

Question 12

Fat Embolism Nursing Responsibility

Answer 12

MONITOR RESPIRATORY STATUS EVERY SHIFT.

Fifty percent (50%) of persons with fat emboli die.

Question 13

Complications for Fat embolism

Answer 13

Infection
Drainage
Unpleasant Odor
Sudden increased temp
HOT SPOT felt
Osteomyelitis

Question 14

Classic symptom of deep vein thrombosis.

Answer 14

Note the unilateral right leg swelling. especially at thigh and calf
at thigh
and calf.

Question 15

What helps for fat embolism?

Answer 15

Bed cradle
Heat
Avoid heavy sedation
Avoid pressure in popiteal space Minimize compression
Active & passive exercises as ordered Frequent change in position

Question 16

COMPLICATION OF FRACTURE

Answer 16

Shock and Blood Loss

Question 17

usually done under anesthesia Carried out through manual traction to move fracture fragments & restore bone alignment Followed by immobilization device (cast)

Answer 17

Closed reduction

Question 18

incision and realignment Usually performed with internal fixation devices (screws, pins, plates, wires)

Answer 18

Open Reduction

Question 19

maintain position for unstable fractures & for weakened muscles, allow for use of contiguous joints while affected part remains immobilized. Common sites include face & jaw, pelvis, fingers.

Answer 19

External Fixation

Question 20

application of a pulling force to an injured body part or extremity while a counter-traction pulls in the opposite direction.

Answer 20

Traction

Question 21

Types of internal fixation

Answer 21

Tension band Wiring #phalanx

Compression plate & screw # femur

Question 22

An abdominal flat-plate is ordered.

This is due to an extrinsic compression of
the third portion of the duodenum by the superior mesenteric artery

Answer 22

CAST SYNDROME

Question 23

Windows maybe cut in dried casts:

Answer 23

1. relieve pressure from abd. distension (body cast)
2. To prevent “Cast Syndrome”
3. To assess radial pulse (check circulation in a casted arm)
4. To inspect areas of discomfort or areas of suspected
   tissue damage
5. To remove drains or care for wounds.

Question 24

Cast Drying Time

Answer 24

Synthetic casts - 20-30mins

Plaster casts - set rapidly but take several hrs to days to completely dry

Question 25

Traction applied to an extremity puts pressure on the peroneal nerve where it passes around the neck of the fibula to just below the knee.
● Pressure at this point may cause________, leading to inability to_________ the foot.

Answer 25

Cause footdrop

dorsiflex the food

Question 26

Inability to plantarflex indicates damage to the_________

Answer 26

tibial nerve.

Question 27

Edema from a fracture causes an increase in compartmental pressure that decreases capillary blood perfusion.
When the local blood supply unable to meet tissue metabolic demands ischemia begins = compromised circulation.
Increase pressure in a confined space due to tight cast, edema or bleeding.

Answer 27

Compartmental Syndrome:

Question 28

COMPARTMENT SYNDROME TREATMENT

Answer 28

Fasciotomy

Question 29

Bloating feeling
-Prolonged nausea: repeated vomiting
- Abdominal distension: vague
abdominal pain
-Shortness of breath
-Untreated may lead to death!

Answer 29

Cast Syndrome

Question 30

A common complication of elbow fractures

May lead to permanently stiff, claw-like deformity of arm & hand

Answer 30

Volkmann’s

Question 31

KNOW THE SIX PS: CAST ASSESSMENT

Answer 31

● Pain
● Pallor
● Paresthesia
● Pulselessness ● Paralysis
● Polar

Question 32

Neuro-vascular problems

Answer 32

Monitor neurovascular status of distal aspects of involved extremities in comparison with corresponding body part after the initial post op period & every 2 hours for the following 24 hours and every 4 to 12 hours thereafter

Question 33

Irreversible tissue death occurs in______

Answer 33

4 to 12 hours..

Question 34

Hemorrhage

Answer 34

Stage 1 = 15% = 750ml

Stage 2 = 15-30% = 1,500ml (subtle sign)

Sage 3 = 30-40%1,500- 2,000ml
(Obvious sign)

Stage 4= 40% >2,000

Question 35

Powerful involuntary muscle contractions shorten the flexor muscles & cause extreme pain. This may be triggered by hypoxia of muscle tissue.

Answer 35

MUSCLE SPASM

Question 36

INTERVENTION: DVT/PE/FES

Answer 36

▪ Client wears elastic stockings.
▪ Teach leg exercises.
▪ Observe for changes in mental status, chest
pain and SOB.
▪ Observe for swelling, redness and pain in legs
(DO NOT MESSAGE).
▪ Fat embolism is the most lethal complication of

Stage I
15%
( up to 750ml)
Stage II
15-30%
(Up to 1500ml) subtle sign
Stage III
30-40%
(1500-2000ml)- obvious shock
Srage IV
40%
(over 2000ml)
●
● ●
● ● ●
●
●
Bones are very vascular. In combination with collateral damage to adjacent structures/vessels, the patient is at risk for hemorrhage.
Shock fully develops if a healthy client looses 1/3 of normal blood volume.
7 - 8% of body wt is blood. An adult hasabout5.5Lof blood.
10% volume loss = tachycardia
30% loss affects B.P
1 unit of packed cells raises Hgb about 1 gram. Check with physician about expected normal loss.
POTENTIAL BLOOD LOSS FOLLOWING FRACTURES (LITERS)
This is not what is expected but what is possible!
Check with surgeon to determine extent of expected blood loss
THR.

Question 37

healing of the bone occur by interstitial groeth of bone in rigid fixation by plate or nai

Answer 37

Primary healing of fracture

Question 38

healing occurs with adequate callus information both interstitial and surroundings, when micro movement occur in stable fixation by POP , cast, locking, plate external fixation.

Answer 38

Secondary fracture healing

Question 39

FRACTURE HEALING OPERATIVE

Answer 39

Reduction and compression
- primary bone healing
- process rehabilitation rapid high risk

Niling or external fixtion
- healing by cllus
- rapid process rehailitation rapid lesser risk